Of note, only 1 patient in the tamsulosin group was withdrawn due to postural hypotension. Apparently tamsulosin acts on the α1A and α 1D receptors in the lower ureter to: decrease ureteral spasm, reduce the force as well as the frequency of ureteral contractions, and block pain transmission via C-fibers.

While it is certainly clear that an alpha blocker benefits passage of stone fragments, be they natural or surgeon-made, the overriding question is why does SWL in 2008 provide such poor results? In this series, part of the reason could be the high treatment rate of 120 shocks/minute, but even given this factor, how many patients are accepting of a therapy with only a 78% success rate after two sessions with the adjunct of tamsulosin? To my mind, this is similar to what we have seen with UPJ obstruction – a less invasive but less successful therapy such as endopyelotomy has largely given way to a more invasive but more successful therapy, specifically, laparoscopic or robotic pyeloplasty. So it goes, with SWL being largely superseded by ureteroscopy at many centers across the United States.